Thinking about the future cognitive remediation therapy--what works and could we do better?

Til Wykes, Will D Spaulding, Til Wykes, Will D Spaulding

Abstract

This article reviews progress in the development of effective cognitive remediation therapy (CRT) and its translational process. There is now enough evidence that cognitive difficulties experienced by people with schizophrenia can change and that the agenda for the next generation of studies is to increase these effects systematically through cognitive remediation. We examine the necessary steps and challenges of moving CRT to treatment dissemination. Theories which have been designed to explain the effects of cognitive remediation, are important but we conclude that they are not essential for dissemination which could progress in an empirical fashion. One apparent barrier is that cognitive remediation therapies look different on the surface. However, they still tend to use many of the same training procedures. The only important marker for outcome identified in the current studies seems to be the training emphasis. Some therapies concentrate on massed practice of cognitive functions, whereas others also use direct training of strategies. These may produce differing effects as noted in the most recent meta-analyses. We recommend attention to several critical issues in the next generation of empirical studies. These include developing more complex models of the therapy effects that take into account participant characteristics, specific and broad cognitive outcomes, the study design, as well as the specific and nonspecific effects of treatment, which have rarely been investigated in this empirical programme.

Figures

Fig. 1.
Fig. 1.
Possible pathways in the meandering pipeline of treatment development
Fig. 2.
Fig. 2.
Effects of mediator and moderator variables on behavior change.

References

    1. Wykes T, Katz R, Sturt E, Hemsley D. Abnormalities of response processing in a chronic psychiatric group—a possible predictor of failure in rehabilitation programs. Br J Psychiatry. 1992;160:244–252.
    1. Wykes T. Predicting symptomatic and behavioral outcomes of community care. Br J Psychiatry. 1994;165:486–492.
    1. Green MF. What are the functional consequences of neurocognitive deficits in schizophrenia? Am J Psychiatry. 1996;153:321–330.
    1. Spaulding WD, Storms L, Goodrich V, Sullivan M. Applications of experimental psychopathology in psychiatric rehabilitation. Schizophr Bull. 1986;12:560–577.
    1. Bellack AS. Cognitive rehabilitation for schizophrenia—is it possible—is it necessary. Schizophr Bull. 1992;8:43–50.
    1. Owen AM, Hampshire A, Grahn JA, et al. Putting brain training to the test. Nature. 2010;465:775–778.
    1. Dickinson D, Tenhula W, Morris S, et al. A randomised, led trial of computer-assisted cognitive remediation for schizophrenia. Am J Psychiatry. 2010;167:170–180.
    1. Kurtz MM, Moberg PJ, Gur RC, Gur RE. Approaches to cognitive remediation of neuropsychological deficits in schizophrenia: a review and meta-analysis. Neuropsychol Rev. 2001;11:197–210.
    1. Wykes T. Review: cognitive remediation improves cognitive functioning in schizophrenia. Evid Based Ment Health. 2008;11:117.
    1. Wykes T, Huddy V, Cellard C, McGurk S, Czobar P. A meta-analysis of cognitive remediation for schizophrenia: methodology and effect sizes. Am J Psychiatry. 2011;168:472–485.
    1. Addington J, Addington D. Neurocognitive and social functioning in schizophrenia. Schizophr Bull. 1999;25:173–182.
    1. Spaulding WD, Fleming SK, Reed D, Sullivan M, Storzback D, Lam M. Cognitive functioning in schizophrenia: implications for psychiatric rehabilitation. Schizophr Bull. 1999;25:275–289.
    1. Wykes T, Reeder C, Corner J, Williams C, Everitt B. The effects of neurocognitive remediation on executive processing in patients with schizophrenia. Schizophr Bull. 1999;25:291–307.
    1. Brekke J, Kay DD, Lee KS, Green MF. Biosocial pathways to functional outcome in schizophrenia. Schizophr Res. 2005;80:213–225.
    1. Spaulding WD, Reed D, Sullivan M, Richardson C, Weiler M. Effects of cognitive treatment in psychiatric rehabilitation. Schizophr Bull. 1999;25:657–676.
    1. Nemeth D, Janacsek G. The dynamics of implicit skill consolidation in young and elderly adults. J Gerontol B Psychol Sci Soc Sci. 2011;66:15–22.
    1. Redondo RL, Morris RGM. Making memories last: the synaptic tagging and capture hypothesis. Nat Rev Neurosci. 2011;12:17–30.
    1. Carter CS, Barch DM, Buchanan RW, et al. Identifying cognitive mechanisms targeted for treatment development in schizophrenia: an overview of the first meeting of the cognitive neuroscience treatment research to improve cognition in schizophrenia initiative. Biol. Psychiatry. 2008;64:4–10.
    1. Spaulding W, Sullivan M, Poland J. Treatment and Rehabilitation of Severe Mental Illness. New York, NY: Guilford Press; 2003.
    1. Brenner HD, Hodel D, Roder V, Corrigan P. Treatment of cognitive dysfunctions and behavioral deficits in schizophrenia. Schizophr Bull. 1992;18:21–26.
    1. Roder V, Mueller D, Brenner HD, Spualding W. Integrated Psychological Therapy. London, UK: Hogrefe; 2010.
    1. Roder V, Mueller D, Mueser K, Brenner H. Integrated psychological therapy: is it effective? Schizophr Bull. 2006;32(suppl 1):S81–S93.
    1. Adcock R, Dale C, Fisher M, et al. When top-down meets bottom-up: auditory training enhances verbal memory in schizophrenia. Schizophr Bull. 2009;35:132–1141.
    1. Hogarty GE, Flesher S. Developmental theory for a cognitive enhancement therapy for schizophrenia. Schizophr Bull. 1999;25:677–692.
    1. Hogarty GE, Flesher S. Practice principles of cognitive enhancement therapy for schizophrenia. Schizophr Bull. 1999;25:693–708.
    1. Wykes T, Reeder C. Cognitive Remediation Therapy for Schizophrenia: Theory and Practice. London, UK: Brunner Routledge; 2005.
    1. Wykes T. Cognitive remediation therapy needs funding. Nature. 2010;468:165–166.
    1. Silverstein SM. Bridging the gap between extrinsic and intrinsic motivation in the cognitive remediation of schizophrenia. Schizophr Bull. 2010;36:949–956.
    1. Gorissen M, Sanz JC, Schmand B. Effort and cognition in schizophrenia patients. Schizophr Res. 2005;78:199–208.
    1. Choi J, Fiszdon JM, Medalia A. Expectancy-value theory in persistence of learning effects in schizophrenia: role of task value and perceived competency. Schizophr Bull. 2010;36:957–965.
    1. McGurk SR, Twamley EW, Sitzer DI, et al. A meta-analysis of cognitive remediation in schizophrenia. Am J Psychiatry. 2007;164:1791–1802.
    1. Silverstein SM, Hatashita-Wong M, Solak BA, et al. Effectiveness of a two-phase cognitive rehabilitation intervention for severely impaired schizophrenia patients. Psychol Med. 2005;35:829–837.
    1. Bell MD, Bryson GJ, Greig TC, Fiszdon JM, Wexler BE. Neurocognitive enhancement therapy with work therapy: productivity outcomes at 6-12-month follow-up. J Rehabil Res Dev. 2005;43:829–838.
    1. Bellack AS, Green MF, Cook JA, et al. Assessment of community functioning in people with schizophrenia and other severe mental illnesses: a white paper based on an NIMH-sponsored workshop. Schizophr Bull. 2007;33:805–822.
    1. Kern R, Liberman RP, Kopelowicz A, Mintz J, Green MF. Applications of errorless learning for improving work performance in persons with schizophrenia. Am J Psychiatry. 2002;59:1921–1926.
    1. Medalia A, Revheim N, Casey M. The remediation of problem-solving skills in schizophrenia. Schizophr Bull. 2001;27:259–267.
    1. Fisher M, Holland C, Merzenich MM, Vinogradov S. Using neuroplasticity-based auditory training to improve verbal memory in schizophrenia. Am J Psychiatry. 2009;166:805–811.
    1. Harvey KE, Galletly CA, Field C, Proeve M. The effects of verbalisation on cognitive performance in schizophrenia: a pilot study using tasks from the Delis Kaplan Executive Function System. Neuropsychol Rehabil. 2009;19:733–741.
    1. Wykes T, Reeder C, Landau S, et al. Cognitive remediation therapy in schizophrenia—randomised controlled trial. Br J Psychiatry. 2007;190:421–427.
    1. Wykes T, Newton E, Landau S, Rice C, Thompson N, Frangou S. Remediation in adolescent onset results of a randomised control trial. Schizophr Bull. 2007;33:610.
    1. Kleim HA, Hogg TM, VandenBerg PM, et al. Cortical synaptogenesis and motor map reorganisation occur during late, but not early, phase of motor skill learning. J Neurosci. 2004;24:628–633.
    1. Danion JM, Meulemans T, Kauffmann-Muller F, Vermaat H. Intact implicit learning in schizophrenia. Am J Psychiatry. 2001;158:944–948.
    1. Rougier NP, Noelle DC, Braver TS, Cohen JD, O'Reilly RC. Prefrontal cortex and flexible cognitive control: rules without symbols. Proc Natl Acad Sci U S A. 2005;102:7338–7343.
    1. Fuchs LS, Fuchs D, Prentice K, et al. Explicitly teaching for transfer: effects on third grade students’ mathematical problem solving. J Educ Psychol. 2003;95:293–305.
    1. Rose D, Farrier D, Doran A-M, Sporle T, Bogner D, Wykes T. What do clients think of cognitive remediation therapy: a consumer led investigation of satisfaction and side effects. Am J Psychiatr Rehabil. 2008;11:181–204.
    1. Medalia A, Richardson R. What predicts a good response to cognitive remediation interventions? Schizophr Bull. 2005;31:942–953.
    1. McGurk S, Mueser K. Response to cognitive rehabilitation in older versus younger persons with severe mental illness. Am J Psychiatr Rehabil. 2009;11:90–105.
    1. Wykes T, Reeder C, Landau S, Matthiasson P, Haworth E, Hutchinson C. Does age matter? Effects of cognitive rehabilitation across the age span. Schizophr Res. 2009;113:252–258.
    1. Kurtz MM, Seltzer JC, Shagan DS, Thime WR, Wexler BE. Computer-assisted cognitive remediation in schizophrenia: what is the active ingredient? Schizophr Res. 2007;89:251–260.
    1. Wykes T, Huddy T. Cognitive remediation for schizophrenia: it is even more complicated. Curr Opin Psychiatry. 2009;22:161–167.
    1. Nakagami E, Hoe M, Brekke JS. The prospective relationships among intrinsic motivation, neurocognition, and psychosocial functioning in schizophrenia. Schizophr Bull. 2010;36:935–948.
    1. Heerey EA, Matveeva TM, Gold JM. Imagining the future: degraded representations of future rewards and events in schizophrenia. J Abnorm Psychol. 2011;120:483–489.

Source: PubMed

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